<form method="post" action="#" class="form-horizontal">
    <h3>Data Contact</h3>
  <fieldset>
	  <div class="control-group">
	    <label for="txtCategory" class="control-label">Kategori:</label>
	    <div class="controls">
	    <select name="txtCategory" id="txtCategory" class="span3">
                <option value="">Pilih</option>
                <option value="Phone">Phone</option>
                <option value="Fax">Fax</option>
                <option value="Messenger">Messenger</option>
                <option value="Email">Email</option>
            </select>
            <font class="strerr"><?=isset($err->upc_category) ? @$err->upc_category:""?></font>
	    </div>
	  </div>
	  <div class="control-group">
	    <label for="txtLabel" class="control-label">Label:</label>
	    <div class="controls">
                <input type="text" name="txtLabel" id="txtLabel" value="<?=@$contact->upc_contact_label?>" class="span3">
	      <font class="strerr"><?=isset($err->upc_contact_label) ? @$err->upc_contact_label:""?></font>
	    </div>
	  </div>
	  <div class="control-group">
	    <label for="txtName" class="control-label">Nama:</label>
	    <div class="controls">
	      <input type="text" name="txtName" id="txtName" value="<?=@$contact->upc_contact_value?>" class="span3">
              <font class="strerr"><?=isset($err->upc_contact_value) ? @$err->upc_contact_value:"";?></font>
	    </div>
	  </div>
        <div class="control-group">
	    <label for="txtPublic" class="control-label"></label>
	    <div class="controls">
	      <label><input type="checkbox" name="txtPublic" value="1"> Publik</label>
	    </div>
	  </div>
          <div class="control-group">
	    <label for="eduCity" class="control-label"></label>
	    <div class="controls">
	      <input type="submit" value="Simpan" class="btn btn-primary">
              <a class="btn btn-default" href="<?= base_url() ?>profile">Cancel</a>
	    </div>
	  </div>
	</fieldset>
</form>